Provider Demographics
NPI:1952713588
Name:RIVERA GUILLAMA, ARIEL (PSYD)
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:RIVERA GUILLAMA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CALLE CORREO
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-2342
Mailing Address - Country:US
Mailing Address - Phone:787-455-3305
Mailing Address - Fax:
Practice Address - Street 1:27 CALLE CORREO
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-2342
Practice Address - Country:US
Practice Address - Phone:787-455-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5334103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical